Why Is My Ankle Sprain Not Getting Better?

Most ankle injuries get better with rest, ice packs, painkillers and physiotherapy with no long-term problems. However, in about 5-10% the pain and instability may continue beyond the usual healing time of 6 to 12 weeks. The ligaments may fail to heal properly and become weak, or there may be damage to the joint itself or some other structure nearby. Ankle instability is when there is a tendency for the ankle to "give way", often with minor stresses making one prone to repeated ankle sprains. This is more commonly due to damage to the proprioceptive nerves than actual weakness of the ligaments. These are small nerve endings in the joint and ligaments which tell the brain where the ankle is and what position it is in. If these nerve endings are not working properly, the brain does not get reliable information and the muscles around the ankle may not work together properly.

How is the problem diagnosed?

It is important to be examined by a specialist to look for any signs that you have some other problem around your ankle, such as damage to the joint surface. Ankle examination will reveal if the ligaments are lax. Investigations may be required like special stress X-ray views, MRI scans to look for ligament damage and other causes of pain

What can be done about ankle instability?

The first treatment is a physiotherapy programme to re-train the proprioceptive nerves which are not working properly, by doing various exercises and activities. Exercises are also shown to stretching and strengthening of the muscles around the ankle. A moulded insole may be advised for your shoe to reduce extra stress on the ankle ligaments. An ankle brace may help to tighten up or replace the ligaments. Many people will find their ankle much more stable and comfortable with physiotherapy.

Will I need an operation?

If problems continue like pain and instability despite other measures an operation might be required. A keyhole surgery (Arthroscopy) may be required to smoothen scar tissue, remove loose joint pieces and assessing ligament status. An operation to reconstruct the ankle ligaments may be needed if tests show that the ligaments are weak/lax.